Provider Demographics
NPI:1265629463
Name:872 HUNTSPOINT PHARMACY INC
Entity Type:Organization
Organization Name:872 HUNTSPOINT PHARMACY INC
Other - Org Name:BOCA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-991-6700
Mailing Address - Street 1:PO BOX 120360
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-0360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:872 HUNTS POINT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5402
Practice Address - Country:US
Practice Address - Phone:718-991-3519
Practice Address - Fax:347-548-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0285423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3355547OtherOTHER ID NUMBER